Radiation Oncology Payer Contracts 2026: Repricing Guide

Most radiation oncology payer contracts 2026 claims are paid under were written for codes that no longer exist. The contract names 77386 and 77014, or G6015 and G6002, or simply says “the current Medicare physician fee schedule.” On January 1, 2026 the codes named in the first two kinds no longer existed, and the third kind repriced automatically, with no action by the payer. A practice that wants its 2025 revenue back has to show the payer, in the payer’s own units, what happened to one course.

This post builds that comparison at national Medicare rates, explains the automatic repricing, and gives the questions, the letter outline and the fee schedule checks that follow from it.

The math is simple. The harder part is getting it to the right person at the payer.

What changed in the lines a contract names

2025 line (freestanding Medicare)	2026 line	What moved
G6015 IMRT delivery, simple (commercial payers generally used 77385 or 77386)	77407 Level 2, or 77412 Level 3 when a criterion is met	IMRT is no longer named; the descriptor says “3D or IMRT”
77014 CT guidance, technical component (or G6002 stereoscopic)	none; technical IGRT is bundled into 77402, 77407 and 77412	A per-fraction technical line was removed
77014-26 or G6002-26, professional component	77387-26	One professional guidance code for all image guidance types
77427 weekly management	77427, unchanged	Slight increase from the conversion factor

Worked comparison: a 20-fraction IMRT course with daily image guidance

The figures below are national non-facility Medicare amounts at the non-APM conversion factor ($32.3465 for 2025 and $33.4009 for 2026), taken from the Radiation Business Solutions summary of the CY 2026 final rule’s Addendum B. They are before geographic adjustment and are not what any practice is paid; they are the rates most contracts reference. The course is a single-isocenter prostate IMRT plan, 20 fractions, daily CT guidance.

Line	2025	2026, Level 2	2026, Level 3
Delivery, 20 fractions	G6015 at $337.37 = $6,747.40	77407 at $317.64 = $6,352.80	77412 at $391.46 = $7,829.20
Technical image guidance, 20 fractions	77014-TC at $71.81 = $1,436.20	bundled, $0.00	bundled, $0.00
Professional image guidance, 20 fractions	77014-26 at $43.99 = $879.80	77387-26 at $36.74 = $734.80	77387-26 at $36.74 = $734.80
Weekly management, 4 units	77427 at $187.93 = $751.72	77427 at $196.73 = $786.92	77427 at $196.73 = $786.92
Course total	$9,815.12	$7,874.52 (-$1,940.60, -19.8 percent)	$9,350.92 (-$464.20, -4.7 percent)
Delivery plus guidance per fraction	$453.17	$354.38 (-21.8 percent)	$428.20 (-5.5 percent)

The management line went up, but by far less than the delivery line went down. If the 2025 guidance was stereoscopic kV imaging billed as G6002 ($53.37 technical, $20.05 professional) rather than CT, the 2025 per-fraction figure is $410.79 and the Level 2 drop is about 14 percent. Planning, simulation and device codes rose 2 to 5 percent in 2026 and are not in the table because they are billed once per course; a complete course model should include them, and will still show the delivery lines as the loss.

How a percentage-of-Medicare contract repriced automatically

Suppose a commercial contract pays 125 percent of the current Medicare fee schedule for radiation oncology. In 2025 the payer allowed 125 percent of $453.17, or $566.46, for each fraction of delivery and guidance. On January 1 it loaded the 2026 RVU file, as the contract requires, and allowed 125 percent of $354.38, or $442.98. The contract did not change, the payer did nothing wrong under it, and the per-fraction allowance fell 21.8 percent, exactly as Medicare’s did. For Medicare that fall was partly offset by the planning and management increases; for the commercial payer it was simply the new price of IMRT.

A contract pegged to a fixed year, say “the 2024 Medicare fee schedule,” behaves differently: it has no amount for 77407 or 77387 at all, so the payer applies whatever its default rule is for unlisted codes, often a lower percentage of current Medicare or a crosswalk of its own choosing. A contract with flat per-code fees has no row either, and those claims deny as not on the fee schedule or price at the default. Todd Doyle, MD, of New York Oncology Hematology told AJMC in April that private payers “did not go in and update their fee schedules,” that many contracts do not require revenue-neutral repricing, and that his request was simple: “pay us for the same amount in 2026,” retroactive to January 1.

Questions to ask the payer

Which fee schedule year and file does the contract reference, and when was the 2026 RVU file loaded?
What amount is loaded for 77402, 77407, 77412 and 77387-26 under this contract, and how was it derived?
If a code is not on the fee schedule, what default rule prices it?
How were authorizations approved under 77385, 77386 or G-codes converted, and what code do claims need to carry?
Is 77387 with modifier 26 recognized as separately payable in every setting under this contract?
Does the payer’s edit set treat 77407’s “3D or IMRT” descriptor as 3D for pricing?
What is the process and the contact for a revenue-neutral adjustment effective January 1, 2026, and for reprocessing claims already paid?

Template letter outline: revenue-neutral repricing effective January 1, 2026

Subject and request. Request for revenue-neutral repricing of radiation treatment delivery and image guidance codes effective January 1, 2026, with reprocessing of affected claims.
What changed. CPT and CMS deleted 77385, 77386, 77401, 77014, 77417 and G6001 to G6017 and replaced them with 77402, 77407 and 77412, with technical image guidance bundled and professional guidance reported as 77387-26. The services delivered to the payer’s members did not change.
The effect under this contract. One table: the practice’s 2025 allowed amounts per fraction for the old codes versus the 2026 allowed amounts for the new codes, with the course total and percentage, using the payer’s own remittances.
The request. Load per-fraction rates for 77407, 77412 and 77387-26 that reproduce the 2025 allowed amount for the equivalent course (IMRT with daily image guidance), effective January 1, 2026; reprocess claims paid at the lower amounts; confirm in writing.
Authorizations. Confirm converted approvals and that claims carrying the new codes will not deny for authorization.
Response date and contact. Name the person, the date and the next step if there is no response.

What to check in your own fee schedule load

Every 2026 code has a row in every payer fee schedule in the billing system, including 77387 with the 26 modifier, and the deleted codes are end-dated December 31, 2025.
Expected allowed amounts are rebuilt from the 2026 RVU file for percentage-of-Medicare payers, not carried forward from 2025.
Charge codes in the record and verify system map to 77402, 77407, 77412 and 77387-26; Iridium Suite’s Record & Verify import from Aria and Mosaiq brings charges in from the treatment system, and the charge codes in the R&V system are the practice’s to maintain, so an old code left in the treatment system arrives on every fraction; see Record & Verify integration.
Posted allowed amounts for 77407 and 77387-26 are compared to the expected amounts payer by payer each month, so a payer that loaded the wrong rate shows up as a monthly variance instead of being found at year end.
Level 2 versus Level 3 mix by payer, since a payer that downgrades every 77412 to 77407 produces the same variance as one that underpriced 77407.

What to do now

Build the course comparison for your three largest commercial payers this month, using your own 2025 and 2026 remittances in place of the national figures above.
Classify each contract as current-year Medicare, fixed-year Medicare or flat fee, because the fix is different for each: a repricing amendment, a fee schedule update or a new rate sheet.
Send the letter with the course table attached and a 30-day response date, and copy the payer’s contracting and medical director contacts.
Ask for 2027 now. The CY 2027 proposed rule would raise 77402, 77407 and 77412 and lower the conversion factor; a current-year Medicare contract will change with it in January, a fixed-year contract will not.
Report payers that will not reprice to ASTRO’s Payer Support and Resolution Center so the specialty’s data includes yours.

Radiation oncology payer contracts 2026: comparing 2025 and 2026 per-fraction revenue and asking for revenue-neutral repricing